Healthcare Provider Details

I. General information

NPI: 1730355140
Provider Name (Legal Business Name): R SARA BUCARO LCSW LICENSED CLINIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12647 OLIVE BLVD SUITE 600
ST LOUIS MO
63141
US

IV. Provider business mailing address

12647 OLIVE BLVD SUITE 600
ST LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 800-325-3982
  • Fax: 877-685-9866
Mailing address:
  • Phone: 800-325-3982
  • Fax: 877-685-9866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989010
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: